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Paranoia: What is it Really?

Paranoid. We’ve all heard that word before. It is often used to describe feelings of suspicion and worry - or a suspicious/worrisome person. Maybe someone labelled your jumpy friend as paranoid. Perhaps someone remarks that they are paranoid they left the stove on.

In fact “paranoid” joins “OCD,” “depressed,” and “ADD” as psychological terms falsely used to denote troublesome - albeit common - human tendencies like melancholy or stickling. Properly used these are not mere adjectives but actual disorders.

So what really is paranoia? Here’s the first definition from the Merriam-Webster dictionary: “mental illness characterized by systematized delusions of persecution or grandeur usually without hallucinations.” A patient’s paranoid mind believes that something malicious is being done to them even when there’s no reason to think so. The impression of persecution and/or conspiracy against one’s self are hallmarks which set paranoia apart from, say, anxiety.

But in researching for this blog I’ve found it’s more complicated than a simple dictionary definition. Paranoia itself does not attach to any one illness. In fact it accompanies a wide range of disorders, and is helped along by various symptoms of each one. It might even be considered a lesser symptom in some cases, and the main illness in others. For this piece, we’ll explore the three main paranoia-based disorders:

First there’s paranoid personality disorder (PPD). This is basically the condensed essence of paranoia itself. PPD sufferers feel that someone is “out to get them” all the time. This leads to distrust in people and disrupted relationships. Patients usually exhibit inability to forgive or take criticism, constant blaming of others for real or perceived slights, refusal to admit wrongs, and a myriad of other problems that arise when one incessantly doubts the intentions of those around them. Romantic relationships, for example, can be plagued by jealousy and constant accusations of cheating.

So far experts believe both biological (having a relative diagnosed with schizophrenia) and circumstantial factors (early life hardships) contribute to PPD. To diagnose PPD, first a doctor will confirm the mental disorder as the cause of a patient’s difficulties. They then send that patient to a psychologist/psychiatrist - if the patient did not seek help directly from a mental health professional. Given the distrusting nature of the disease, sometimes sufferers are unwilling or reluctant to undertake treatment.

Second on the “paranoia disorders” list is paranoid schizophrenia (some doctors now refer to this as schizophrenia with paranoia). In all cases of schizophrenia, a patient’s mind breaks with reality allowing for false notions and delusional thinking. Paranoid schizophrenia happens to be the most prevalent form of the disease, featuring delusions which lead to feelings of persecution. In this case hallucinations are sometimes present, although not always.

Antipsychotic drugs are often prescribed to treat this disorder along with regular therapy sessions. It is vital to continue taking prescribed medication as instructed. Failure to do so may result in relapse of delusions and paranoia. In extreme cases hospitalization may be required.

Finally, we come to delusional disorder. Although not always focused on paranoia, that part comes into play when the delusion is persecutory. Though delusions are often bizarre in nature (or at the very least unwarranted), patients exhibit no impaired behavior. This sets delusional disorder apart from PPD and paranoid schizophrenia. For a positive diagnosis, delusions must be present for a month or longer.

Its rarity has made delusional disorder hard to research and study, but as with PPD many doctors believe it stems from a mix of genetic and early childhood factors. Chances of developing this disorder increase when a family member has schizophrenia. Once again many sufferers deny an illness which makes it harder to treat. If treatment is sought, the same strategy of medication and therapy is usually administered.

In most cases, paranoid disorders are chronic. The chances of successful treatment are stymied by many patients’ reluctance to admit to having a mental illness. However, greater mental health awareness in recent years provides a spark of hope. It may be difficult to come to terms with, but if you or anyone you know may be suffering from a paranoia disorder, please do seek help. Proper treatment can only improve relationships and quality of life.

Note: For assistance with behavioral health issues, contact us at 305-740-3340 or schedule an appointment with BregmanMD.


Bhandari, Smitha (2018, May) Paranoid Personality Disorder. Retrieved on January 17 from

Goldberg, Joseph (2017, October) What is Paranoid Schizophrenia? Retrieved on January 18, 2019 from

Victoria State Government (2016, November) Paranoia. Better Health Channel. Retrieved on January 17, 2019 from

Wikipedia contributors. (2019, January 19). Delusional disorder. In Wikipedia, The Free Encyclopedia. Retrieved 00:32, January 25, 2019, from

By BregmanMD | February 01, 2019 | Mental Health

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